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Comparative effectiveness of screening and prevention strategies among BRCA1/2-affected mutation carriers

  • Epidemiology
  • Published:
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Abstract

Comparative effectiveness research has become an integral part of health care planning in most developed countries. In a simulated cohort of women, aged 30–65, who tested positive for BRCA1 or BRCA2 mutations, we compared outcomes of mammography with and without MRI, prophylactic oophorectomy with and without mastectomy, mastectomy alone, and chemoprevention. Methods: Using Treeage 9.02 software, we developed Markov models with 25,000 Monte Carlo simulations and conducted probabilistic sensitivity analysis. We based mutation penetrance rates, breast and ovarian cancer incidence, and mortality rates, and costs in terms of 2009 dollars, on published studies and data from the Surveillance, Epidemiology, and End Results (SEER) Program and the Centers for Medicare and Medicaid Services. We used preference ratings obtained from mutation carriers and controls to adjust survival for quality of life (QALYs). Results: For BRCA1 mutation carriers, prophylactic oophorectomy at $1,741 per QALY, was more cost effective than both surgeries and dominated all other interventions. For BRCA2 carriers, prophylactic oophorectomy, at $4,587 per QALY, was more cost effective than both surgeries. Without quality adjustment, both mastectomy and BSO surgeries dominated all other interventions. In all simulations, preventive surgeries or chemoprevention dominated or were more cost effective than screening because screening modalities were costly. Conclusion: Our analysis suggested that among BRCA1/2 mutation carriers, prophylactic surgery would dominate or be cost effective compared to chemoprevention and screening. Annual screening with MRI and mammography was the most effective strategy because it was associated with the longest quality-adjusted survival, but it was also very expensive.

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Acknowledgment

This study was supported by Grant #: RSGHP-03-166-01-PBP Research Scholar Grant from the American Cancer Society, Atlanta, GA. (SpinOdyssey) Westport, CT and the Avon Family Foundation. Dr. Hershman is the recipient of a grant from the National Cancer Institute (NCI R01CA134964).

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Authors and Affiliations

  1. Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA

    Victor R. Grann, Judith S. Jacobson, Maxine Ashby-Thompson, Dawn L. Hershman & Alfred I. Neugut

  2. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Victor R. Grann, Dawn L. Hershman & Alfred I. Neugut

  3. Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, Room 734, 722 West 168th Street, New York, NY, 10032, USA

    Victor R. Grann, Judith S. Jacobson, Dawn L. Hershman & Alfred I. Neugut

  4. Department of Health Policy and Management, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA

    Victor R. Grann

  5. Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Priya R. Patel

  6. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Ellen Warner

  7. Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Daniel F. Heitjan

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  1. Victor R. Grann
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Grann, V.R., Patel, P.R., Jacobson, J.S. et al. Comparative effectiveness of screening and prevention strategies among BRCA1/2-affected mutation carriers. Breast Cancer Res Treat 125, 837–847 (2011). https://doi.org/10.1007/s10549-010-1043-4

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